Early and late results following combined coronary bypass surgery and mitral valve replacement

Abstract

To study the effect of various perioperative and operative variables, we analysed the results of 66 consecutive patients undergoing mitral valve replacement (MVR) and coronary artery bypass grafting (CABG). The mean age was 61.2 years (34 males and 32 females), the mean follow-up 54.71 +/- 7.8 months. The hospital mortality rate was 7.6% (5/66). New York Heart Association (NYHA) functional class (P < 0.01), left ventricular global wall motion score (increased scores indicating impaired function, P = 0.005) and cross-clamp time (P < 0.05) were associated with hospital mortality. There was no significant relationship of age (certainly up to the age of 70), cause of mitral valve disease, severity of mitral regurgitation, number of grafts, presence of angina, or previous myocardial infarction with hospital mortality. There were eight late deaths, survival at 1, 3 and 5 years was 92.4%, 83.2% and 80.2%, respectively. Although there was a trend for pulmonary vascular resistance (P = 0.15), NYHA class (P = 0.18) and aortic cross-clamp time (P = 0.09) to be associated with late survival, the only factor significantly related to late survival was global wall motion score (P = 0.001), i.e. those with scores of more than 10. Severity of mitral regurgitation and cause of mitral valve disease have been reported as being related to late survival in patients undergoing combined CABG and MVR, but we have found no such relationship. Our results indicate that both hospital and late mortality after this operation are strongly correlated with left ventricular function.

Mitral Valve Replacement or Repair After Previous Coronary Artery Bypass Grafting

“…Five-and 10-year survival of 61% and 38% in this group are rates comparable with those of other reports of primary MVR and CABG. 1,18,22 EFϽ50%, NYHA class IV, use of the intra-aortic balloon pump, and urgent or emergency operation were significant predictors of late death. Left ventricular dysfunction has been found to be a significant predictor of adverse long-term survival in many studies of MVR or MVR and CABG.…”

“…Previous studies of primary MVR and MV repair with CABG have not shown a consistent correlation between origin and early mortality. 1,9,22,23 On the other hand, others have found that ischemic mitral regurgitation was a predictor for early death after combined MVR and MV repair and CABG. 14,24 Our failure to find this may reflect the small numbers in each group in the present study.…”

Impact of Smoking Status on Outcomes after Concomitant Aortic Valve Replacement and Coronary Artery Bypass Graft Surgery

“…Most modern series quote a variable, but greater early mortality rate of 6.3 to 13.5% compared with 1.7 to 5.5% for isolated CABG or AVR procedures. [4][5][6][7][8] Many risk factors have been identified for an increased mortality including age, diabetes mellitus, renal dysfunction, New York Heart Association (NYHA) class, poor left ventricular function, ischemic valve dysfunction, urgent operation, increased cross-clamp time and bypass time, blood transfusion, and prior cardiac surgery. 4,6,[8][9][10][11][12][13] Despite cigarette smoking being a powerful risk factor for coronary artery disease, myocardial infarction, and cardiac death, its effect on outcomes after combined CABG and AVR remains equivocal.…”

Combining off pump coronary artery bypass with mitral valve replacement

“…Prolonged CPB and ACC times have been known contributory factors to elevated operative risk in concomitant CABG /MVR procedures 19,20 .…”